June 1, 2009, 5:00 AM CT

Obesity predicts inadequate bowel prep at colonoscopy

Obesity is an independent predictor of inadequate bowel preparation at colonoscopy, and the presence of additional risk factors further increases the likelihood of a poorly cleansed colon, as per a newly released study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.

Obesity has become an epidemic in the present era, both in the U.S. and in other developed nations. Abnormal elevation of body mass index (BMI) is linked to several gastrointestinal diagnoses, including diverticular disease, gastroesophageal reflux disease, colon polyps and colon cancer.

Since the majority of colon cancers arise from adenomatous (benign) colon polyps, proper screening becomes crucial while performing colonoscopy on obese patients. An inadequately cleansed colon can jeopardize the effectiveness of screening or surveillance colonoscopy, exposing these patients at higher risk for colorectal tumors to the dangers of missed lesions and higher cost of repeat colonoscopy.

"The implications of our findings are profound. Since over a quarter of all patients had an inadequate examination, identification of a patient profile with a high risk for poor colon preparation will be helpful in capturing those who would benefit from an initial individualized designer preparation regimen," said Brian Borg, MD, of Washington University in St. Louis, MO and main author of the study. "Our results suggest that the obese patient should at least be subject to more precise instructions and possibly a more rigorous bowel preparation regimen. In addition, as the number of risk factors for an inadequate bowel preparation increase, the need for early repeat colonoscopy escalates"......... Posted by: JoAnn      Read more         Source

June 1, 2009, 4:55 AM CT

Longer high-stakes tests may result in a sense of mental fatigue

Spending hours taking a high-pressure aptitude test may make people feel mentally fatigued, but that fatigue doesn't necessarily lead to lower test scores, as per new research published by the American Psychological Association. If anything, performance might actually improve on a longer test, the study found.

"The experience of fatigue during testing does not appear to be, in and of itself, detrimental to test performance," said co-authors Phillip Ackerman, PhD, and Ruth Kanfer, PhD.

The study, in the June Journal of Experimental Psychology: Applied, stemmed from concerns that when taking longer tests over several hours in one sitting, students would feel increasingly fatigued, and, in turn, perform worse. High-stakes tests are typically used for admission to college and to regulated professions such as medicine, law and accounting.

Cognitive fatigue -- a sense of being mentally worn out or exhausted -- is actually only partly determined by the length of the test, as per the research. Some people simply seem to feel it more than others in situations that demand prolonged concentration and mental effort.

In the study, 239 freshman college students from the Atlanta area took three different versions of the SAT Reasoning Test. Under conditions simulating the actual exam, with start times of 8 A.M. on three consecutive Saturdays, the students completed tests specially constructed for three different durations: 3.5, 4.5 and 5.5 hours. (The current SAT is 3.75 hours of testing over a 4.5-hour session. In this study, the short version of the test had one less of the verbal, math and writing sections; the long version had one more of each. Otherwise, the tests were the same.) Students received a cash bonus if they beat their prior SAT scores......... Posted by: JoAnn      Read more         Source

May 27, 2009, 9:18 PM CT

Why Eczema Often Leads To Asthma ?

A number of young children who get a severe skin rash develop asthma months or years later. Doctors call the progression from eczema, or atopic dermatitis, to breathing problems the atopic march.

Now researchers at Washington University School of Medicine in St. Louis have uncovered what might be the key to atopic march. They've shown that a substance secreted by damaged skin circulates through the body and triggers asthmatic symptoms in allergen-exposed laboratory mice.

The findings, published May 19, 2009, in Public Library of Science Biology, suggest that early therapy of skin rash and inhibition of the trigger substance might block asthma development in young patients with eczema.

Fifty percent to 70 percent of children with severe atopic dermatitis go on to develop asthma, studies show. By comparison, the rate of asthma incidence among the general population is only about 9 percent in children and 7 percent in adults. Seventeen percent of U.S. children suffer from atopic dermatitis, eventhough not all cases are considered severe.

"Over the years, the clinical community has struggled to explain atopic march," says study author Raphael Kopan, Ph.D., professor of developmental biology and of dermatology. "So when we observed that the skin of mice with an eczema-like condition produced a substance previously implicated in asthma, we decided to investigate further. We observed that the mice also suffered from asthma-like responses to inhaled allergens, implicating the substance, called TSLP, as the link between eczema and asthma."........ Posted by: JoAnn      Read more         Source

May 27, 2009, 9:12 PM CT

Risks of Dementia drug treatment

Side effects linked to several commonly-prescribed dementia drugs appears to be putting elderly Canadians at risk, says Queen's University Geriatrics professor Sudeep Gill.

Cholinesterase inhibitors (Aricept, Exelon and Reminyl) are often prescribed for people with Alzheimer's disease and related dementias because they increase the level of a chemical in the brain that seems to help memory. Eventhough such drugs are known to provoke slower heart rates and fainting episodes, the magnitude of these risks has not been clear until now.

"This is very troubling, because the drugs are marketed as helping to preserve memory and improve function," says Dr. Gill, who is an Ontario Ministry of Health and Long-term Care Career Scientist, working at Providence Care's St. Mary's of the Lake Hospital in Kingston. "But for a subset of people, the effect may be the exact opposite."

In a large study using province-wide data, Dr. Gill and colleagues discovered that people who used cholinesterase inhibitors were hospitalized for fainting almost twice as often as people with dementia who did not receive these drugs. Experiencing a slowed heart-rate was 69 per cent more common amongst cholinesterase inhibitor users. In addition, people taking the dementia drugs had a 49 per cent increased chance of having permanent pacemakers implanted and an 18 per cent increased risk of hip fractures......... Posted by: JoAnn      Read more         Source

May 27, 2009, 9:08 PM CT

New cellular targets for HIV drug development

Focusing HIV drug development on immune cells called macrophages instead of traditionally targeted T cells could bring us closer to eradicating the disease, as per new research from University of Florida and five other institutions.

In the largest study of its kind, scientists observed that in diseased cells such as cancer cells that are also infected with HIV, almost all the virus was packed into macrophages, whose job is to "eat" invading disease agents.

What's more, up to half of those macrophages were hybrids, formed when pieces of genetic material from several parent HIV viruses combined to form new strains.

Such "recombination" is responsible for formation of mutants that easily elude immune system surveillance and escape from anti-HIV drugs.

"Macrophages are these little factories producing new hybrid particles of the virus, making the virus probably even more aggressive over time," said co-author of study Marco Salemi, Ph.D., an assistant professor in the department of pathology, immunology and laboratory medicine at the UF College of Medicine. "If we want to eradicate HIV we need to find a way to actually target the virus specifically infecting the macrophages".

The work was published recently in the journal PLoS ONE........ Posted by: Mark      Read more         Source

May 26, 2009, 6:50 PM CT

Can we afford the cancer care of the future?

When a cancer patient and his or her doctor discuss the value of a therapy option, the conversation commonly centers on a consideration of the therapy's medical benefits versus its possible side effects for the patient. Increasingly, however, as the already high costs of cancer care continue to rise, a full view of the patient's welfare must also take into account the economic impact of the therapy on the patient and his or her family.

Additionally, beyond its clear impact on patients, the increasing cost of cancer care also presents challenges to other stakeholders involved in the development and delivery of care.

"Cancer care is one of the most expensive areas of health care today, and the cost of that care is increasing steadily, for patients and for society as a whole," says Neal J. Meropol, M.D., director of the gastrointestinal cancer and gastrointestinal tumor risk evaluation programs at Fox Chase Cancer Center. Meropol, who is also a member of the American Society of Clinical Oncology (ASCO) Cost of Care Task Force and main author on the upcoming ASCO Guidance Statement on the Cost of Cancer Care, offered his analysis of the problem in a talk presented at the ASCO annual meeting in Orlando today.

"As physicians, we have a responsibility to understand the impact that the increasing cost of cancer care has on everyone involved," Meropol notes. "In particular, we need to be able to discuss with our patients the impact that high out-of-pocket expenses might have on them and their families, however difficult that conversation might be. More and more, cost considerations have an appropriate role in the evaluation of therapy options"......... Posted by: Janet      Read more         Source

May 26, 2009, 6:34 PM CT

The evolution of migraine

Patients living with migraine have strong reason for new optimism concerning a positive future. Two review articles and an accompanying editorial, "The Future of Migraine: Beyond Just Another Pill," in the current issue of Mayo Clinic Proceedings, are the basis for an ironic premise.

"Migraine is a potentially chronic, progressive disease that substantially affects patients, families, workplaces, and society," as per the editorial written by Roger Cady, M.D., of the Headache Care Center in Springfield, Mo. "Ironically, this is the springboard for renewed optimism of a more positive future for patients living with migraine."

Traditionally, Dr. Cady explains, migraine has been considered a pain disorder involving separate or even sporadic episodes. Now, the condition is defined as an all-encompassing and progressive disease that negatively affects all aspects of an individual's life. Migraine can erode quality of life during what should be a person's most productive years, as per Dr. Cady. Because migraine patients' quality of life has not improved at a pace with medical advances, research is addressing the overall severity and potential progressive nature of migraine, particularly migraine episodes as a forerunner of chronic migraine.

As per the three articles, these new insights and understandings are requiring professionals to explore well beyond traditional migraine management. "Understanding migraine as a potentially chronic disease mandates a collaborative health care model with patients and health care professionals working in a partnership toward common therapeutic goals," writes Dr. Cady, specifically intervention and prevention. Physicians and patients must be encouraged to be partners, he says, and assessment must go far beyond the doctor just asking, "How are your migraines?" The models must include an invitation to comprehend and address all migraine-related health issues facing patients, Dr. Cady writes. In addition, understanding the evolutionary "stages" of migraine from sporadic to persistent offers an opportunity to develop new therapies that individualize and personalize care......... Posted by: Daniel      Read more         Source

May 26, 2009, 6:32 PM CT

Youth baseball-related injuries down 25 percent

Spring marks baseball season for more than 19 million children and adolescents who play each year as part of a team or in backyards throughout the United States. The good news for these players is that the number of injuries from the sport is on the decline. A newly released study by the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital observed that the number of children and adolescents treated for baseball-related injuries in hospital emergency departments decreased 25 percent from 1994 through 2006 going from an estimated 147,000 injuries in 1994 to approximately 111,000 injuries in 2006. This is the first national study of youth baseball injuries requiring emergency therapy, and is now available online in the June electronic issue of Pediatrics

"Eventhough baseball injuries have declined, the consistently high numbers of injuries requiring emergency therapy highlight the importance of increasing our prevention efforts," said co-author of study Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children's Hospital, and an associate professor of pediatrics at The Ohio State University College of Medicine.

As per the study, being hit by the baseball was the most common mechanism of injury (46 percent of injuries), followed by being hit with the bat (25 percent). The most common types of injuries were soft tissue injuries (34 percent) followed by fractures and dislocations (20 percent). The face (34 percent) and the upper extremities (32 percent) were the most usually injured body regions......... Posted by: Janet      Read more         Source

May 26, 2009, 6:30 PM CT

pioglitazone against multiple sclerosis

A drug currently FDA-approved for use in diabetes shows some protective effects in the brains of patients with relapsing remitting multiple sclerosis, scientists at the University of Illinois at Chicago College of Medicine report in a study currently available online in the Journal of Neuroimmunology

In a small, double-blinded clinical trial, patients with relapsing remitting multiple sclerosis were assigned to take pioglitazone (a drug commercially known as Actos used to treat type-2 diabetes) or a placebo. Patients continued their normal course of treatment during the trial.

Standard neurological tests were done initially, as were MRI scans to provide baseline values for lesions typically seen in MS patients. The patients were reviewed every two months, and blood samples were taken. Repeat MRI scans were done after five months and again after one year.

Patients taking pioglitazone showed significantly less loss of gray matter over the course of the one-year trial than patients taking placebo. Of the 21 patients who finished the study, patients taking pioglitazone had no adverse reactions and, further, found taking pioglitazone, which is administered in an oral tablet, easy.

"This is very encouraging," said Douglas Feinstein, research professor of anesthesiology at UIC. "Gray matter in the brain is the part that is rich in neurons. These preliminary results suggest that the drug has important effects on neuronal survival"......... Posted by: Daniel      Read more         Source

May 24, 2009, 8:47 PM CT

Opposites attract: how genetics influences humans

New light has been thrown on how humans choose their partners, a scientist will tell the annual conference of the European Society of Human Genetics today (Monday May 25). Professor Maria da Graa Bicalho, head of the Immunogenetics and Histocompatibility Laboratory at the University of Parana, Brazil, says that her research had shown that people with diverse major histocompatibility complexes (MHCs) were more likely to choose each other as mates than those whose MHCs were similar, and that this was likely to be an evolutionary strategy to ensure healthy reproduction.

Females' preference for MHC dissimilar mates has been shown in a number of vertebrate species, including humans, and it is also known that MHC influences mating selection by preferences for particular body odours. The Brazilian team has been working in this field since 1998, and decided to investigate mate selection in the Brazilian population, while trying to uncover the biological significance of MHC diversity.

The researchers studied MHC data from 90 married couples, and compared them with 152 randomly-generated control couples. They counted the number of MHC dissimilarities among those who were real couples, and compared them with those in the randomly-generated 'virtual couples'. "If MHC genes did not influence mate selection", says Professor Bicalho, "we would have expected to see similar results from both sets of couples. But we observed that the real partners had significantly more MHC dissimilarities than we could have expected to find simply by chance"......... Posted by: JoAnn      Read more         Source